Abstract
Pregnancy is a known risk factor for severe Coronavirus disease 2019. It is important to develop safe vaccines that elicit strong maternal and fetal antibody responses. Registries (ClinicalTrials.gov, the WHO Clinical Trial Registry, and the European Union Clinical Trial Registry) and databases (MEDLINE, ScienceDirect, Cochrane Library, Proquest, Springer, medRxiv, and bioRxiv) were systematically searched in June 20-22, 2021, for research articles pertaining to Covid-19 and pregnancy. Manual searches of bioRxiv and medRxiv were also conducted. Inclusion criteria were studies that focused on Covid-19 vaccination among pregnant women, while review articles and non-human studies were excluded. Infection rate, maternal antibody response, transplacental antibody transfer, and adverse events were described. There were 13 observational studies with a total of 48,039 pregnant women who received mRNA vaccines. Of those, three studies investigated infection rate, six studies investigated maternal antibody response, seven studies investigated antibody transfer, three studies reported local adverse events, and five studies reported systemic adverse events. The available data suggested that the mRNA-based vaccines (Pfizer-BioNTech and Moderna) can prevent future SARS-CoV-2 infection. These vaccines did not show clear harm in pregnancy. The most commonly encountered adverse reactions were pain at the injection site, fatigue, and headache, but these were transient. Antibody responses were rapid after the first vaccine dose. After the booster, antibody responses were stronger and associated with better transplacental antibody transfer. Longer intervals between first vaccination dose and delivery were also associated with higher antibody fetal IgG and a better antibody transfer ratio. The SARS-CoV-2 mRNA vaccines are encouraged for pregnancy. These vaccines can be a safe option for pregnant women and their fetuses. Two vaccine doses are recommended for more robust maternal and fetal antibody responses. Longer latency is associated with higher fetal antibody responses. Further research about its long-term effect on pregnancy is needed. PROSPERO (CRD42021261684).
Highlights
Since the beginning of the Covid-19 pandemic, extensive efforts have been made to end this global disaster
The available data suggested that the mRNA-based vaccines (Pfizer–BioNTech and Moderna) can prevent future SARS-CoV-2 infection
The SARS-CoV-2 mRNA vaccines are encouraged for pregnancy
Summary
Since the beginning of the Covid-19 pandemic, extensive efforts have been made to end this global disaster. Most pregnant women suffer only mild to moderate symptoms, SARS-CoV-2 infection is more severe in pregnant women than in others, with increased risks of hospital admission, intensive care unit stay, and death [4] Despite their higher risk of SARS-CoV-2 infection, pregnant and lactating women were not included in any initial Covid-19 vaccine trials, resulting in a lack of data to guide vaccine decision-making in these populations [5]. A previous study revealed that most pregnant women with Covid-19 admitted to hospital were asymptomatic, which allows these undetected patients to transmit the virus to others [6–8]. This shows that efforts to prevent SARS-CoV-2 infection, such as by vaccination, are critical for investigations on this population. We systematically review the latest evidence on Covid-19 vaccination to summarize its efficacy, immunogenicity, and safety profile in pregnant women
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